Kinga Dyndał

Depressive disorders (DDs), especially treatment-resistant depression (TRD), pose a significant challenge worldwide, largely because their underlying biological mechanisms are complicated and treatments often fall short. There is growing evidence pointing to factors like disrupted neuroplasticity, neuroinflammation, irregularities in the hypothalamic–pituitary–adrenal (HPA) axis, and glutamatergic system imbalances as contributors to the onset and persistence of depressive symptoms. Exosomes (small extracellular vesicles involved in communication between cells) have recently gained attention for their potential role in connecting peripheral and central nervous system (CNS) changes. They carry proteins, lipids, and nucleic acids and are even capable of crossing the blood–brain barrier. Because of this, exosomes might provide a window into molecular changes in the brain and serve as accessible biomarkers of disease status and treatment response. Recent research points out that the contents of exosomes, especially microRNAs (miRNAs) and neurotrophic factors like brain-derived neurotrophic factor (BDNF), might play a part in disrupting synaptic plasticity and could be linked to resistance to antidepressants. At the same time, there is growing interest in using engineered exosomes as targeted drug carriers aimed at the CNS. That said, there are still quite a few hurdles to overcome. Methods vary widely between studies, protocols for isolating exosomes are not sufficiently standardized, safety data are limited, and we do not fully understand how drugs and exosomes interact or how they behave pharmacokinetically. This review brings together current findings regarding exosomes in DDs (with particular emphasis on TRD), highlights their promise for diagnosis and treatment, and sets out some of the main questions that need to be answered before clinical application becomes feasible.

Age-related macular degeneration (AMD) is a disease leading to severe central vision loss and blindness in people over 60 years. [1] The pathogenesis of this disease is multifactorial and complex interactions of metabolic, functional genetic, and environmental factors - it is not fully known. [2] For the above reasons, the effectiveness of the therapies used is limited. Although the disease involves changes in the anatomical and functional complex, including photoreceptors, retinal pigment epithelium (RPE), Bruch's membrane, and choriocapillaris layer, the essence of the disorder and its earliest stage is the progressive degeneration and atrophv of the RPE cells. leadina conseauentiv to irreversible damaae to photoreceptors. Four processes occurring within the mentioned complex contribute to the development of AMD: lipofuscinogenesis, drusogenesis, inflammation, and neovascularization. [3]

Background: Heart disease remains a leading cause of maternal mortality worldwide, exacerbated by pregnancy-related physiological changes affecting cardiovascular function, respiratory dynamics, hematological parameters, and pharmacokinetics—all of which influence maternal and fetal outcomes, as well as anesthetic management. Cardiac arrhythmias may be intensified by hemodynamic and hormonal changes during pregnancy. Furthermore, conditions such as peripartum cardiomyopathy, Takotsubo syndrome, myocardial infarction, and post–heart transplantation complications increase the risk of arrhythmias and adverse maternal and fetal outcomes, requiring specialized management to mitigate complications such as heart failure, thromboembolism, and cardiac arrest.Aim of the study: To review current evidence on anesthetic management in pregnant women with cardiac arrhythmias and other arrhythmia-inducing heart diseases.Material and methods: The review was conducted using articles and guidelines from PubMed, the National Institutes of Health (NIH), the Medycyna Praktyczna website, SpringerMedizin, Semantic Scholar, and book sources. Based on 420 articles, 4 books, and WHO/NIH sources, 43 key references (20 published after 2022) were analyzed.Results: Pregnancy induces significant cardiovascular and respiratory changes. Respiratory adaptations and hematologic alterations affect anesthesia and drug pharmacokinetics. Arrhythmias such as atrial fibrillation are treated with beta-blockers, verapamil, or cardioversion. The risk of arrhythmia is 47.91 times higher in patients with cardiomyopathy than in healthy individuals. Peripartum cardiomyopathy carries a high risk of arrhythmias. Takotsubo syndrome, often occurring in the peripartum period, is associated with catecholamine surges and is managed with beta-blockers and diuretics. Myocardial infarction is also associated with an increased risk of developing arrhythmias during pregnancy. Heart transplant recipients frequently experience concomitant cardiac arrhythmias and face significantly increased risks of maternal morbidity and preterm birth, necessitating specialized, multidisciplinary care.Conclusions: Pregnancy-induced physiological adaptations increase the risk of arrhythmias and require specialized management to mitigate maternal and fetal complications. Optimal outcomes depend on multidisciplinary care, individualized anesthesia, and rigorous monitoring.

Introduction and purpose: An anterior cruciate ligament (ACL) injury is one of the most common knee joint injuries, particularly among athletes. Its reconstruction is one of the most frequently performed orthopedic procedures, enabling a return to full physical function. However, a crucial component of recovery is a well-planned and consistently implemented postoperative rehabilitation program, which helps reduce the risk of reinjury. This review discusses the individual stages of rehabilitation, the methods used, and their role in minimizing the aforementioned risk. Material and methods: A comprehensive review and analysis of the literature from 2000 to 2025 was conducted using the PubMed, Google Scholar, Scopus, and Web of Science databases (including randomized controlled trials, meta-analyses, and guidelines). The focus was on various rehabilitation methods following ACL reconstruction and their impact on reducing the risk of reinjury. Brief description of the state of knowledge: Current guidelines and studies identify four phases of rehabilitation: early, intermediate, late, and return to sport. Modern rehabilitation protocols vary in terms of progression rate, techniques used, and tools for assessing therapy outcomes. The psychological aspect is also emphasized, as fear of reinjury can have a significant impact on recovery. Conclusions: Rehabilitation programs based on functional criteria and individualization allow for precise adaptation of therapeutic interventions to the patient’s needs at different stages of the recovery process, thereby significantly reducing the risk of reinjury. Moreover, modern technologies such as biofeedback, virtual reality, and biomechanical analysis can enhance the effectiveness of therapy by improving exercise precision and enabling better monitoring of the patient’s progress.

Background and Aim: Depression and cardiovascular diseases (CVDs) are major global health burdens with significant overlap. Increasing evidence supports a bidirectional relationship between them, driven by shared mechanisms such as HPA axis dysregulation, inflammation, autonomic imbalance, and behavioral risk factors. Depression increases the risk of cardiovascular events and worsens outcomes in CVD patients. This review explores psychocardiological mechanisms behind this comorbidity and assesses the efficacy of pharmacological and behavioral treatments—including cognitive behavioral therapy (CBT), cardiac rehabilitation programs (CRPs), and consultation-liaison psychiatry (CLP)—in improving patient outcomes. Materials and Methods: A narrative review was conducted using sources from PubMed, Scopus, and ClinicalTrials.gov, including meta-analyses, cohort studies, and clinical guidelines. The review focused on the comorbidity of depression and CVD, underlying mechanisms, and the effects of interventions. Results: Depression affects up to 25% of coronary artery disease patients and elevates the risk of adverse cardiac events. Mechanisms include chronic stress, HPA axis hyperactivity, systemic inflammation, and autonomic dysfunction. CBT and positive psychology interventions were associated with reduced myocardial infarction incidence and angina symptoms. CRPs improved quality of life and reduced depression and anxiety. CL psychiatry helped manage psychiatric comorbidities and enhanced adherence in hospitalized patients. Conclusions: Depression is a modifiable, independent risk factor for CVD. Early screening and integrated interventions—including CBT, CRPs, and CL psychiatry—are effective in improving psychological and cardiovascular health. Personalized, multidisciplinary care is essential for optimal outcomes in patients with comorbid depression and CVD.

Introduction: Heart rate variability (HRV) is a non-invasive biomarker reflecting autonomic nervous system activity. In recent years, its use in sports medicine has increased significantly due to its usefulness in monitoring training load, recovery, and cardiovascular health in athletes. Material and methods: This review summarizes the current state of knowledge on the physiological basis of HRV, measurement methods, and practical applications in athlete populations. This study is a literature review based on data from PubMed and Google Scholar. Results: HRV parameters, particularly RMSSD (the square root of the mean of the squares of differences between successive RR intervals) and SDNN (the standard deviation of NN intervals), show a clear sensitivity to training intensity and recovery status. Studies show that HRV-guided training can improve performance measures such as VO₂max (maximal oxygen consumption) and reduce the risk of overtraining. HRV also responds to changes related to sleep quality, supplementation, and biofeedback interventions. Despite technological advances, there are still challenges related to standardizing measurement protocols and accuracy across devices. Low HRV is also associated with increased cardiovascular risk, which additionally creates a potential role in early detection of arrhythmia or autonomic imbalance in athletes. Conclusions: HRV is a valuable tool in personalized training management and monitoring cardiovascular health. The use of similar measurement protocols and interpretation of trends rather than single values increases its utility in both competitive and recreational sports. Future research should seek to integrate HRV with other physiological measures and validate wearable technologies in diverse athlete populations.

Introduction: The human gut microbiome has become the subject of intensive scientific research in recent years due to its significant impact on the body. Disturbances in its composition, called dysbiosis are linked to diseases such as inflammatory bowel disease (IBD), obesity, type 2 diabetes, allergies and neuropsychiatric disorders. This review summarizes current knowledge about the gut microbiome - its composition, functions, research methods, therapeutic options and health impact. Materials and methods: The review was based on an analysis of scientific literature from the PubMed database. The selected publications concerned the composition and development of the microbiome, its function in the pathogenesis of diseases and diagnostic methods and therapeutic strategies. Results: The gut microbiome is a complex ecosystem of bacteria, viruses, fungi and archaea. It develops from the perinatal period depending on delivery mode, feeding, diet, antibiotics, and lifestyle. It ferments undigested components into short-chain fatty acids (SCFA), synthesizes vitamins, modulates immunity and protects against pathogens. Dysbiosis is linked to chronic inflammation "leaky gut" and metabolic, autoimmune and neuropsychiatric diseases. Therapies include probiotics, prebiotics, synbiotics, diet changes, fecal microbiota transplantation (FMT) and new methods such as bacteriophages or precise microbiome editing using CRISPR-Cas technology (a biological system that bacteria and archaea use to defend against viruses). Conclusions: Growing evidence supports the critical role of the gut microbiome in health. Although the links between dysbiosis and disease are clear, direct causality remains uncertain. Future research should identify key microorganisms, develop personalized therapies based on microbiota modulation and ensure the safety of treatments. Properly shaping the microbiome may open new possibilities for preventing and treating chronic diseases.

Introduction: Osteoporosis in men is an increasingly acknowledged but underdiagnosed public health issue. Despite accounting for 20% of osteoporosis cases, male patients are frequently overlooked due to lower awareness, stereotypical associations with female aging, and subtler clinical presentation. Mortality following hip fractures in men reaches up to 37%. This review summarizes current knowledge and highlights emerging concepts in male osteoporosis. Material and Methods: A narrative review based on a PubMed literature search and analysis of international osteoporosis guidelines (2017–2025). Included were high-quality reviews, randomized trials, and position statements focused on osteoporosis in men. Results: Male osteoporosis is mainly secondary, linked to hypogonadism, androgen deprivation therapy, glucocorticoids, chronic disease, and poor lifestyle factors such as alcohol, smoking, low activity, and vitamin D deficiency. Diagnosis remains challenging due to female-based T-score thresholds and limitations of FRAX in male populations. Bone turnover markers and HR-pQCT imaging improve risk stratification. Treatment combines antiresorptive agents (bisphosphonates, denosumab) and anabolic therapies (romosozumab), often sequenced under treat-to-target (T2T) models. New approaches include the role of gut microbiota, osteosarcopenia, and personalized digital tools. Conclusions: Male osteoporosis requires earlier recognition, individualized therapy, and public awareness. Advancing care involves closing diagnostic gaps, integrating male-focused strategies into clinical guidelines, and embracing novel therapeutic targets and technologies.

Modern lifestyles involve increasing exposure to artificial light sources, particularly from electronic devices emitting blue-enriched light. Blue light, due to its short wavelength and high photon energy, may affect retinal structures and disrupt circadian regulation, leading to sleep disturbances. Additionally, recent studies suggest that blue light exposure may influence cognitive performance, alertness, and subjective wellbeing, especially in young adults and physically active populations. The aim of this systematic review was to synthesize current evidence regarding the effects of artificial blue light on visual function, sleep quality, and human wellbeing. The review explored the underlying biological mechanisms, including the activation of melanopsin-containing intrinsically photosensitive retinal ganglion cells, and evaluated the potential risks associated with prolonged exposure to low-illuminance blue light from digital screens. Findings indicate a consistent relationship between blue light exposure and disruptions in sleep–wake cycles, with emerging data pointing toward broader psychophysiological implications. The review highlights the need for further research to better define safe exposure thresholds, assess individual sensitivity, and evaluate protective strategies such as blue light filters.

Purpose of the study: The aim of this literature review is to synthesize current knowledge on the clinical management of athletes with T2DM, focusing on pharmacological strategies, exercise recommendations, nutritional interventions, self-monitoring technologies, and interdisciplinary education to ensure safety and performance optimization. Materials and methods: A literature review was conducted using databases such as PubMed, Google Scholar, and Scopus. Articles published between 2000 and 2024 were included if they addressed physical activity, training strategies, medication management, or patient education in individuals with T2DM—particularly in athletic or physically active populations. Key publications included guidelines from the American College of Sports Medicine (ACSM), American Diabetes Association (ADA), and peer-reviewed reviews from Diabetes Spectrum, MDPI Sports, and Medical Sciences Sports Exercise. Results: The reviewed literature confirms that regular physical activity improves insulin sensitivity and glycemic control in patients with T2DM. However, exercise regimens must be personalized to avoid glycemic complications. Pharmacotherapy should consider the risk of hypoglycemia and dehydration, especially when using insulin or SGLT2 inhibitors. Nutritional strategies, such as pre-exercise carbohydrate intake and hydration protocols, are critical. Technological tools like continuous glucose monitoring (CGM) enhance real-time decision-making. Multidisciplinary education increases adherence and safety in diabetes care among athletes. Conclusions: Athletes with T2DM can achieve excellent glycemic control and high levels of performance if therapeutic strategies are personalized, evidence-based, and supported by education and technology. Further clinical studies are needed to develop sport-specific recommendations for this unique population.